Friday, June 6, 2008

Naturopathy Licensing in USA

Guidelines for foreign trained Naturopaths in USA

In the United States, health care practitioners are licensed by the state they practice in; consequently, there is no one set of rules or steps toward licensure that will apply to all state licensing requirements. A requirement common to all licensing jurisdictions is that the applicant must have passed the Naturopathic Physicians Licensing Exam (NPLEX). In order to be eligible to sit for NPLEX, an applicant must document a naturopathic medical education from (or equivalent to that of) the post-graduate degree programs of the approved North American naturopathic medical colleges.

As of May, 2000 no foreign trained practitioner has presented documentation of a naturopathic medical education from an institution outside of the US or Canada which successfully demonstrates academic and clinical courses equivalent to the standards of North American naturopathic medical schools. Therefore, the North American Board of Naturopathic Examiners has not yet approved any foreign trained practitioner to sit for the NPLEX, and no state licensing board has granted a license to practice to any candidate not educated in an approved North American naturopathic medical college.

The following information is provided to assist foreign trained practitioners in beginning their research about licensure requirements. We urge you to be sure to collect and verify all your information directly from officials in the state(s) where you are interested in practicing.
Licensure is dictated by each states' statutes. Most states require the following:

1. The applicant be a graduate of an accredited naturopathic medical school.
2. The medical education should be a four-year post-graduate level program; that is, the equivalent of four, 36-week academic years.
3. The applicant must have passing scores on the Naturopathic Physicians Licensing Exam.
4. The applicant must also have passing scores on any add-on exams particular to that state. For example, Jurisprudence, Acupuncture or Homeopathy may be required.

In unlicensed states:
• No statutes regulate or define the profession
• Practitioners cannot use the public designation doctor or physician.
• Practitioners cannot diagnose or prescribe without the risk of being charged with violating the medical practice act, or practicing medicine without a license.

International Credential Evaluation Services:
In preparing documentation to present to a college admissions committee or to a state licensing agency, it is recommended that foreign trained applicants provide professionally translated transcripts to one of these services for evaluation. Untranslated or illegible documentation will not be accepted for evaluation by the agencies below, the state licensing agencies, or any college admissions office.

NPLEX is the standard examination used by all licensing jurisdictions for Naturopathic physicians in North America. It includes 5 basic science exams (anatomy, physiology, pathology, biochemistry, microbiology and immunology), which are taken after the first 2 years of medical school. The clinical science examinations are taken following graduation after the 4th year of school. They include: clinical and physical diagnosis, laboratory diagnosis and diagnostic imaging, botanical medicine, pharmacology, nutrition, physical medicine, homeopathy, minor surgery, psychology and lifestyle counseling, and emergency medicine. Individual jurisdictions may give additional examinations in jurisprudence and acupuncture.

NPLEX has announced the creation of a new organization: the North American Board of Naturopathic Examiners (NABNE). NPLEX will retain its role as the producer of a transnational board licensing examination; the NPLEX Board has been restructured so that exam development will be its sole focus. The NABNE will take on the role of gathering input from the various constituencies involved in the profession (jurisdictions, schools, associations, etc.). In addition, the NABNE will begin two new functions. First the NABNE will be the point of application for students and candidates who want to take the NPLEX. NABNE will review credentials to make certain that applicants meet the criteria for examination. Second, the NABNE will set up testing centers in the U.S. and Canada for administration of the exams. The impetus for creating the NABNE stems primarily from the desire to maintain high standards within the profession. The first function (approving candidates to sit for the exams) will ensure that the NPLEX exams are taken only by candidates who have been appropriately trained at accredited naturopathic medical colleges. The second function (administering the NPLEX exams) will ensure that the exams are administered without bias and are kept secure. The NABNE Board will be responsive to the input of an advisory committee comprised of appointees from the jurisdictions, the schools, the Council on Naturopathic Medical Education (CNME), the Federation of Naturopathic Physicians Licensing Authorities (FNPLA), and the national associations, as well as several public members. Input from the Advisory Committee will be critical for setting examining standards and for coordinating the effort. As currently proposed, applicants will apply to the NABNE to take the NPLEX Basic Science Exams. The NABNE will ensure that the applicant meets the standards set with input from the Advisory Committee and if everything is complete, will send exam booklets to the exam administration site of choice for that applicant. The NABNE will arrange all examination sites and proctors. NPLEX will score the exams, and NABNE will send score reports directly to the examinees.

Licensing Boards need no longer be involved with the approval or administration process for the Basic Science Exams. At graduation from an approved school, eligible candidates will again apply to the NABNE to be approved to take the Clinical exams; the NABNE will send exam booklets to the candidate's exam site of choice (again arranged and proctored by the NABNE). NPLEX will score the exams, NABNE will send score reports directly to the candidates, and will then send transcripts of the candidate's Basic Science and Clinical exam scores to the jurisdiction where the candidate wants to be licensed.

Please note, the NABNE is NOT a licensing board, the jurisdictions still hold all authority for investigating the credentials of and approving candidates for licensure. The NABNE is an examining board, responsible only for the examination process. This is similar to the model followed in many other health care professions including the National Board of Medical Examiners and the National Board of Chiropractic Examiners where applicants apply to a central agency for examination. We see it as a very positive step both to reduce confusion among applicants regarding where they should apply to take the NPLEX, and to reduce work by the jurisdictions in terms of time that will no longer be spent in approving the applicants to sit for, and administering the exams.

1. The recommended route is to apply to one of the accredited naturopathic medical colleges as an advanced standing student, and transfer applicable academic credits from your previous education. An admissions committee will determine the specific program requirements (meaning academic courses and/or clinical preceptor-ship) needed in order to be granted the naturopathic medical degree from that institution. The details of such a program must be crafted to satisfy the criteria for the college degree, the NPLEX and the state board exam requirements. Proficiency in English medical/scientific terminology is essential. There is no other route that will guarantee your application for licensure will be favorably considered.

2. Document your education, supplying for instance very specific and complete course content descriptions, faculty credentials and academic credit hour equivalents, and submit these with a request for consideration as an applicant to the North American Board of Naturopathic Examiners. That credentialing body will then evaluate your documentation and if it is determined to represent an equivalent education, allow you to sit for the NPLEX. If you pass the NPLEX, any state you apply to for licensure will also evaluate your documentation in a separate process, in order to determine eligibility for licensure in that jurisdiction. This is a lengthy and individualized process, which no foreign trained practitioner has, as of May 2000, successfully completed. North American Council on Naturopathic Medical Education (CNME) trains primary care physicians, and the course content and length of study in programs outside the US and Canada tend not to be sufficiently similar.